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Dental Photography Resources

Throughout my childhood I wanted to be an artist. When I graduated from high school I decided that the best way to not be a “starving artist” was to get a degree in Design. Obviously, I didn’t follow that career path exactly. Now I consider being a dentist fulfilling my desire to be a “designer”. Many of the fundamentals I learned there about composition, proportion, and color theory are a nice supplement to executing the esthetic aspect of the dentistry we provide. One part of my design training was commercial photography. For the past twenty years I have enjoyed taking photos of people and places-- for the past decade photography has developed as a critical tool in our delivery of quality dentistry.Digital Photography is a tool that our practice uses everyday to document our patients oral condition. Our team finds it useful for educating patients and communicating with our laboratory and specialists. We have found that the most effective way to take photographs is with a standard series of photos taken from outside the mouth with a digital SLR camera aided with mirrors and retractors that hold the cheeks out of some shots. Lately, I have enjoyed teaching dental photography to colleagues.I wanted to use our blog to list a few resources for beginning the journey into dental photography for your practice.Lester DineLester Dine has providing Photography Equipment for years and has several packages that are put together to get started. They are resourceful at providing settings for there products that take some of the guess work out.PhotoMedPhotoMed is the other major exclusive online store for dental photography. Between Lester Dine and PhotoMed most of your needs should be covered. I suggest shopping between the two to choose a system that suits your taste and budget.AdoramaAdorama is a very complete online photography discount store for general photography needs. If they don’t have what you are looking for you probably don’t need it. If you are comfortable putting together your own SLR/ Flash/ Macro lens combination you might save significantly over the dental specific sites.

Smile Line is a boutique web store for high end dental lab equipment. It sells very nice flexible and soft contrasters.

Modern Denture Alternatives

Exciting Solutions for Missing Teeth

Not a day goes by at our dental office that we do not meet patients that have lost the opportunity of having their teeth. We meet people that cannot realistically maintain health with their natural teeth. We meet people that are looking for solutions, but are not aware of options. Unfortunately, we meet people that simply say, “pull them all . . . I’d rather have a denture.” On the other hand, we meet people that have had it with their dentures and given the opportunity to advise the person seeking dentures, would try to talk them out of it. In each of these encounters, conversations begin difficult, perhaps even uncomfortable for people coming to our practice. We simply move beyond the negative and focus on the joy in the possibilities we have to offer.

In the first half of my career, I was less willing to consider choices that replaced teeth at all cost. First and foremost, we advocate treasuring the natural dentition for its significance in the health of people’s lives. I was always reluctant to offer any solution that fell short of enjoying perfect teeth. Now we have some very exciting options for replacing teeth that are comfortable, reliable, functional, and very . . . very attractive!

The advent of dental implants has changed dentistry forever. A single implant with a crown placed over it is the standard of care for replacing a single missing tooth. Today we are able to use the same technology to offer several different restorative options for the edentulous mouth (missing all teeth). It is now reasonable to look at a patient with confidence and tell them, when appropriate, that replacing their severely diseased teeth or ill-fitting dentures with implant-supported restorations is not only an option, but also a great choice! Not only can patients that have struggled with a life of tooth emergencies or embarrassing and uncomfortable experiences with dentures have a reliable solution, but also a hope of the possibility of enjoying a beautiful smile. In addition to using implants as anchorage for the dentistry over them, implants stimulate tooth supporting oral bone, that would otherwise atrophy, to stay intact. Implant supported restorations not only look great but feel and function like natural teeth.

Today the options for supporting and retaining the replacement of an arch of teeth with implants are better than ever in our practice. These choices range from simply using a couple of implants with snaps to retain traditional dentures that would otherwise “slip” to a full arch of exquisite porcelain crowns that are permanently affixed in the mouth and virtually serve as a true replacement for severely damaged teeth. From a health standpoint, knowing how detrimental oral inflammation is to overall systemic health, for some patients it is absolutely critical to end chronic oral disease before it has negative effects on the cardiovascular system or at least before the risk of infection becomes an eminent threat to a patients well being. From a happiness standpoint, patients are able to enjoy healthy food and one of the simplest pleasures in life (that is also one of our basic needs) SMILING. When we ask patients how they see themselves dentally in the future our conversation always turns to the value of investing in quality dentistry. I would like to progressively share some of our implant restoration offerings.

Locator Retained Over-Denture

If a patient is interested in a traditional denture but wants the assurance that they will never have to place “denture paste” under it, the most basic implant solution we can offer is an implant retained over denture that use a precise attachment called a locator. The locator is affixed to the top of the implant and a fitting inside the denture snaps to it. In fact, we simply cannot recommend a lower denture, which traditionally does not stay in place well without offering two locators as an option. This has become the standard of care for lower dentures and proves effective on upper dentures as well.

Montreal Bar

Bar Supported Over Denture

While single locator/implants aid to retain teeth the following options all support prostheses keeping them from pushing inward toward tissue during chewing, speech and function. The Montreal bar supported over denture utilizes a precision milled titanium bar that is affixed over several implants. Unlike bar over dentures in the past that were made of cast gold, titanium has the benefit of being durable but also light. The removable denture snaps over the bar. The monorail-like bar not only keeps the denture in place but also rigidly keeps it from moving laterally and impinging tissues. This improves function greatly mimicking the nature chewing motion since users do not have to posture muscles while enjoying food and speaking. Since the denture is designed on the outside similar to a traditional denture, gum and bony tissue that has diminished is returned to a more full contour.

Titanium Hybrid Bridge

Unlike over dentures that are removed from the mouth, with implants we also have several options that stay in the mouth at all times. We simple ask patients, “would you like to brush your teeth in your mouth or in your hands?” The Titanium Hybrid Bridge relies on a rigid precision milled titanium framework that has nano-resin teeth set in denture acrylic over it. The term “hybrid” refers to the acrylic that like a denture fills in the space of missing gum and bones to the proper position teeth should be placed in. Unlike a denture, the hybrid is only removed periodically at professional dental cleanings. This option virtually becomes the patient’s teeth by being affixed permanently to the implant below it.

Prettau Hybrid Bridge and Bridge

Our Prettau offerings rely on a state-of the-art milled Zirconia framework and Zirconia teeth. Zirconia is a carbon based white metal that is extremely strong and is now commonly used for tooth colored crowns. Because of its opacious white qualities it can make a very esthetic restoration.

Prettau Hybrid Bridge

The Prettau Hybrid Bridge is a milled restoration that has solid tooth colored zirconia teeth over a zirconia framework. Tissue colored porcelain is then applied over the gum tissue areas. Like the Traditional Hybrid, this restoration is permanently fixed in place over dental implants.

Prettau Bridge

In situations where gum and bone structure is still in its

full contour, the Prettau Bridge can be placed. Like the Prettau hybrid it is a fixed arch of zirconia teeth, however there is little or no pink porcelain applied to mimic gums and it sits closer to natural tissue. Because zirconia is the material of choice for crowns on severe tooth grinders, it serves very not wear like resin denture teeth.

Zurick Bridge

The Zurich Bridge is perhaps one of the finest engineered dental prostheses available. Frankly, it is possible to make them even more esthetic than even natural teeth (or veneers). In essence, when perfectly designed, our team is working on a blank canvas. The Zurick Bridge has a zirconia framework like the Prettau Hybrid with individual preparations that protrude toward the biting surface that mimic individual crown preparations. On top of each of these preparations, individual EMax crowns are placed. Emax is the ultimate in dental esthetics and is our porcelain of choice in cosmetic dentistry. Over the framework tissue-colored EMax porcelain is artistically designed to mimic healthy gums. When dentistry is done perfectly, even the gums have to be beautiful. Healthy is beautiful. Like other hybrid implant restorations, the Zurick Bridge is permanently attached to the dental implants that support it.

Why William Kelly Dentistry?

Our practice realizes that there are many choices available for dental care. We also realize that while every patient considers perfect dentistry, not all seek it and even fewer find it. We are proud to offer these advanced restorations for missing teeth and find that our practice is unique in offering them. There are other dental practices that offer similar options for implant dentistry for patients with complete missing teeth. We find that in some instances the case is poorly designed or under engineered. In other instances, this type of dentistry does not utilize the best resources to get the best result. Our office is a firmly believes in a team approach to complex dentistry. We have partnered with the best surgeons to aid in the design and placement of our dental implants. There is a misconception that there will be a run around when working between a specialist and restorative dental office. We work seamlessly with our surgeons through intentional planning and excellent communication. Our choice of dental laboratory matters.Our small lab is a pioneer in the field of complex implant restoration and a critical choice in our outcome. Not only do they provide the restorations described above, they invented the technology in most of them. Our lab’s ceramicist is regarded as one of the best in the world.

What is involved in this type of dentistry?

First and foremost, we want to reach a firm diagnosis for each individual considering this type of dentistry. When deemed appropriate, we design a treatment plan to address our patient’s needs and desires. We design the outcome in a mockup and together with our lab and periodontal surgeons determine the implants needed to support the chosen restoration. As the implants are healing we typically rely on an intermediate traditional denture as the implants integrate into bone. This period serves to verify that the chosen tooth design is pleasing. In some circumstances, if our patient desires, we can affix the temporary restoration over the implants the day they are placed. There are several steps along the way and when the end is reached we pause and smile at the results!

We have not experienced a circumstance in which this type of dentistry has not been an absolute positive change for the life, health, and happiness of the patients that chose to pursue implant dentistry with us. Yes, there is a significant investment involved in the choice to replace unaesthetic, failing teeth so perfectly. We find that each of our clients cannot put a price on the value they sense in their new smile!

Artistry = Best Dentistry

The Lost Art of Waxing

This week my team was blessed to welcome our talented laboratory technicians from Precision Dental Arts in Twin Falls, Idaho. Together with a few close colleagues and my clinical and laboratory assistants, Leigh Ann and Tanum. We spend the day learning about Full Contour Dental Waxing from Jason Boyse.

Creating teeth from wax is the first thing a dental student learns. At UNC, I spent six hours a week for the first year of school in a lab waxing teeth over a stone model of a mouth. With a sore neck, wax melted into my pants, and burns on my finger tips from hot instruments and wax carvers I would shape little wax crowns and veneers and wait in line for my instructors to evaluate them. It was not uncommon to finish a tooth perfectly, perhaps better than the instructing dentist was capable of, only to have him crush the delicate form between his fingers and say, “almost”. This miserable Karate Kid and Mr. Miyagi-like experience taught me the intricacies of dental anatomy, function and the importance of detail.

Waxing has always been critical to the production process of dentistry. The traditional way crowns have been made is investing a waxed pattern of the restoration, burning it out and casting gold into its form. Today, beautiful and durable molten ceramic is similarly pressed into investments of these waxed teeth. Unfortunately, with the advent of digital dentistry, the art of waxing is being lost. Teeth can be designed in digital environment and milled. Yes, my practice depends onthis technology daily. It produces a nice precise fitting restoration-- but we value teeth designed at the wax level for a degree of artistry that a computer can not create. When we want front teeth to have a shape and texture that mimics nature and is absolutely beautiful it takes an artist and this process. For back teeth restorations to not only touch correctly, but have the level of contour and anatomy to function and feel like real teeth they need to be waxed by a knowledgeable master.

Jason Boyse is truly an artist and a master of full contour waxing, dental anatomy, and smile design. Watching Jason’s hands at work is a rare treat. He can make teeth grow out of wax the way God designed them to develop in our bodies. With my team and a few close friends, I had a great day of hands on learning improving the way we shape teeth with Jason’s advice. Having the opportunity to learn more from Jason’s talent will be reflected in our dentistry in many ways. Our assistants’ temporaries will become even better and my discussion and ability to bring excellent smile design to my patients from our lab with be even richer. From Jason’s wax-ups we can mockup smile design in the patient’s mouth to try the look and feel of their future restorations. Ultimately, combining good planning and artistry makes better dentistry. We are blessed to have an exceptionally talented team.

Resolutions, dental flossing, and oral inflammation. Oh, my!

I am a firm believer in New Year’ Resolutions (freeze) . . . I know what you are thinking! Most resolutions last a few weeks and then taper off. Almost every dentist is familiar with the cycle of, “I started flossing two days before this appointment and did it for about three weeks after.” Resolutions have become important and effective for me because I have made them a process of identifying 1) “what is going on” 2) “is this beneficial” 3) “how will it affect the future” 4) “what is a reasonable alternative” 5) “is it realistic to take on the new behavior/habit/goal” 6) “is there a way to be held accountable for this change?” At home, I make little resolutions about health, schedules, and relationships all year round. In our dental practice, the cycle and patterns of our businesses year coincide nicely with the calendar. The coming of a New Year and winter has become a time that we look inward on our practice, assess who we are and what we provide, discuss our vision, and make commitments as a team.

This year one theme we have focused on is educating our patients about the link between oral inflammation and other systemic diseases. The story about why I want to approach this more directly than ever is almost humorous. A few months ago, I was watching the movie, The Hangover. If you have seen this outrageously funny film you know that throughout the movie the character “Stu” is told by friends and other people he encounters that he isn’t really a doctor . . . he’s just a dentist. This wouldn’t have made me think so much except the next day I was reading a blog and the author said the same thing in response to their own real life experience with dental treatment. To be clear, I don’t correct kids when they call me “Mr. Kelly”, in fact I like it when my patients call me simply “Will”. I was not offended by hearing a jab at our profession twice in 24 hours, but it made me curious. What about the dental experience gives the perception that oral health is not medicine? For a few weeks I thought about it and came to two conclusions. Both have to do with the perceived value of maintaining (and perhaps investing in) optimum oral health. The first conclusion is that for some people, dentists are only providers of an emergency service. It may be related to discomfort and they rarely enjoy the benefits of the best our profession has to offer. As a dental professional, the best I can do for folks is continue to be an advocate for dental health and hope that I am heard. The second group of people that may not perceive dentistry as a true medical science make me the most curious. They are what spurred my resolution. You might be one of them, I know at one point in my life I was!

“YOU’RE TEETH LOOK GREAT!” “YOU ARE DOING SUCH A GOOD JOB, I DON’T EVEN NEED TO CHECK YOU!” “THIS IS GOING TO BE FAST BECAUSE YOU ARE PERFECT!”No wonder some patients think that dentists aren’t doctors! An appointment like this offers little value to the patient and the dental provider despite being in the presence of health does little for the patient—who knows maybe a conversation about health could save their mother’s life. No wonder these folks think of a cleaning appointment like a manicure or a haircut—it has nothing to do with health.

We try to meet patients where they are when they come to us for dental care. If they have a mouthful of cavities, sure the discussion is about cavities. Believe it or not the majority of my patients rarely, if ever, get tooth decay! So of course we talk to patients about other diseases that we prevent and treat as dentists. Naturally, patients begin to hear about gum disease or cracked teeth as it begins to be more likely for them. We have also changed many lives by acknowledging the major diseases that affect the entire chewing system in our practice’s focused CENTER FOR BITE DISEASE AND CRANIO-MANDIBULAR DISORDERS. My resolution for this year is specifically developing a focused CENTER FOR ORAL INFLAMATION in our practice for our community.

Studies that have linked oral inflammation and systemic diseases are not new, but they are finally becoming fully appreciated and understood by the whole medical community. I was very fortunate attend the Dental School in Chapel Hill and hear lectures by a pioneer researcher and theorist in this area, Dr. Steven Offenbacher. I am even more fortunate to have the periodontists in my larger team be part of this early research at UNC and continue to be advocates for reducing oral inflammation as it relates to total health.

Oral biofilm (a.k.a plaque and certain oral bacteria) is the largest cause of oral inflammation and generally oral inflammation is the number one cause of inflammation in humans. Leading cardiologists are now looking to periodontal disease as an important source of inflammation related to cardiovascular disease. The link between gum disease and diabetes is well established. It is likely that lifelong oral inflammation (rather common by the way) may present a risk factor similar to being a smoker. Wow!

So this is what you might hear me say if you come to my office with “no problems”:

“Suzie you smile looks great and your teeth are very structurally sound. Great job! You know, I wanted to talk to you about why improving how you floss and developing a few better habits at this point in your life may have a significant affect in your health as you age. . .”

-or-

“Mrs. Smith, I see that you have a new prescription here for a cardiovascular condition. I would like to talk to you about the best we can offer as dentists to help contribute to improving your overall health. Would you mind if we discussed the relationship between your heart condition and some things we are seeing in your mouth?”

When you come to see us we promise to be your “mouth doctor” (and you can still call me “Will”!). I have made a resolution to inspire those I encounter to live healthy and be a teacher of things I understand well. I am encouraging those that I meet and seek my advice to ask questions and resolve to take action on the answers. You’ve all heard the old saying, “only floss the teeth you want to keep”. Now you know a new one, “floss if you want to live longer.”